NHHA LEGISLATIVE UPDATE
January 29, 2009
A number of bills and themes from the 2008 legislative session are back this year. Privacy legislation has returned, this time in the form of three bills. Legislators are once again proposing to document the size of the state’s uninsured by forcing providers to submit “dummy” claims on services provided to uninsured patients. Trial attorneys are trying to undo the pretrial screening panel law by either repealing the statute or weakening it.
Hospitals are once again being targeted by the governor and the legislature for harmful Medicaid cuts. Hospitals were hit for $30 million in November, 2008, and now HB 30 is poised for passage next week to take away another $4 million from hospitals through June, 2009.
Highlighted below are bills we’ve been focused on so far this session:
Medicaid
House action on HB 30, the Governor’s FY
2009 budget cutting bill, has been rescheduled for
February 4th. Among its multi-state agency
budget cutting provisions, the bill attempts to prohibit
hospitals from billing the NH Medicaid program for
provider-based physician services by codifying an
ill-conceived federal Medicaid rule that’s expected to be
suspended as part of Congress’ economic stimulus package.
The Legislature is poised to pass the bill to deal with the
state’s looming deficit, without even knowing precisely what
the impact will be for hospitals. NHHA estimates these cuts
to be $4 million through 6/30/09, while DHHS has understated
the cut at $2 million (state and federal funds).
The Finance Committee has committed to conduct an in-depth analysis of the impact of HB 30 on hospitals as well as the intent of the statutory language (the federal Medicaid rule), to work out the disparities between NHHA and DHHS in our estimates and interpretations. The work on this study will begin next week.
And while we’re fighting back cuts to hospitals in the current fiscal year, we’ll be gearing up for what the Governor has in store for the next biennial budget – FY 2010/2011 – which he will present to the Legislature on February 12th. The projected deficit for the next biennium is $500 million. We may be looking at a budget that’s 90% of the adjusted authorized budget for FY 2009.
Quality and Patient Safety
Adverse events reporting legislation has been introduced.
HB 592, “relative to adverse events in hospitals” is
modeled after the Minnesota reporting law. The bill calls
for hospitals to report to DHHS any of the adverse events as
described by the National Quality Forum, and submit their
root cause analysis and corrective action plan within 60
days of the event. The bill also requires DHHS to publish
an annual report describing, by facility, the adverse events
reported. Our efforts on this bill will focus on hospitals’
continued collaborative efforts to improve quality and
patient safety through the NH Quality Commission.
Infection reporting is back again. HB 40 would impose sanctions on hospitals that fail to report infection rates. NHHA testified that all New Hampshire hospitals are collecting infection data as of January 1, 2009, and will submit their first reports to DHHS by May 31, 2009. There is no need for the legislation, but if passed, it would be left to the discretion of the HHS Commissioner to take any action.
HB 433 proposes to fund the DHHS hospital infection reporting program. In anticipation of being turned down for funding, the bill’s sponsor offered an amendment to the bill that would impose an annual fee on hospitals that would be used to fund the program. However, DHHS is already carrying out the infection reporting program without additional funds. NHHA is on record in opposition to the amendment.
Privacy
We’re looking at three bills, which stem from
last year’s privacy legislation, and which combined, are
nearly identical to the bill that failed to pass muster last
year. The most problematic bill is HB 580, “relative to
health information and patient rights,” which imposes
restrictions on the use of electronic medical records;
allows for individual patients’ opt-out for disclosure of
personal health information; and requires providers to
provide audit trails (the entire audit report) to patients
upon request. NHHA will continue to work with our partners
(NH Medical Society, BIA insurers, counties, and many more)
to oppose such restrictions.
HB 542, “relative to health information exchange,” is proposed as a placeholder in the statute to accommodate a future HIE entity; and HB 619, “relative to medical records and patient information,” redefines HIPAA’s definition of marketing and fundraising, and includes a reporting requirement to the Attorney General for unauthorized disclosures by business associates.
No hearings have been scheduled yet.
Health Insurance
SB 63, “relative to ensuring consumer access to
care upon the termination of a participating provider,”
requires insurers’ Network Adequacy reports to be available
to consumers and employers so they can make informed
decisions about the health insurance coverage and provider
networks that they purchase. Currently, network adequacy
reports are not readily accessible to the public, and if the
carrier so wishes, are not accessible at all. NHHA supports
this bill.
Another bill, “relative to standardizing health insurance claim forms,” has not yet been introduced, but NHHA has learned it would prevent hospitals from billing carriers using the provider-based methodology (a private sector version of HB 30?) We’ve surveyed all hospitals and found that none bill in this manner. More importantly, however, is that this issue does not belong in statute, and should be addressed by the carriers through the contracting process.
Health Care for the Uninsured
Senator Maggie Hassan is re-introducing
legislation from 2008, SB 147, “relative to data
collection practices of health care providers” to
require healthcare providers to submit to the state pseudo
or dummy claims for services provided to uninsured
patients. This claims data would be integrated into the
state’s Comprehensive Health Information System. NHHA
opposed this bill last year due to the undue burden and
other technical problems placed on providers.
Senator Hassan has introduced a companion bill, SB 158, “establishing a commission to study the creation of an uncompensated care fund to provide payments to certain healthcare providers.” Members of the commission would include NHHA, the NH Medical Society, HHS Commissioner, Insurance Commissioner, the Endowment for Health, Citizens’ Health Initiative, legislators, insurance carriers, and other provider representatives. While NHHA is not generally opposed to study commissions, the commission’s charge as stated in the bill is to create an uncompensated care fund to pay healthcare providers who serve a disproportionate share of uninsured patients. We are very concerned that such a commission would be based on the premise that healthcare charitable trust assets be allocated to entities outside the trust’s service area. Furthermore, such an approach undermines the very heart of New Hampshire’s community benefits statute which recognizes that each community is unique with its own specific health needs. No hearing has been scheduled yet.
Medical Liability
A slew of bills have been introduced that are
designed to weaken the laws that require pretrial screening
panels in medical liability actions. HB 50 would repeal
the entire screening panel statute. HB 203 would
retain the law but eliminate the requirement that the judge
present unanimous findings of the panel to the jury. HB 572
would make pretrial screening panels optional. NHHA is
working with the Business & Municipal Coalition to
Preserve Fairness to defeat these bills.
Certificate of Need
HB 234 establishes a committee to study the CON process.
NHHA supports this bill, which stems from last year’s
efforts to authorize the CON Board to adopt an expedited
review process for routine capital projects that exceed the
capital threshold. The House HHS Committee may add an
amendment that addresses renovation projects.
HB 113 extends the moratorium on nursing home and rehabilitation hospital beds. This bill is expected to pass.
A complete list of bills NHHA is following is available at www.nhha.org/nhha/state_law/bills.php. Go to http://www.gencourt.state.nh.us/bill_status/ to view the list of bills NHHA is tracking.